Conejo Valley Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Melissa Shubin arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single-story home located in a residential neighborhood. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:52 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 12/04/2025. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/22/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. INTERVIEWS: Starting at 9:57 a.m. two (2) staff and two (2) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are five (5) total bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a shared, double occupancy resident room. There is no staff room and Administrator stated that staff remain awake at night. Two (2) out of five (5) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are two (2) total restrooms. One (1) is designated as a shared / common resident restroom, One (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 106.2 - 106.7 degrees Fahrenheit, all within the required range. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 118.6 degrees Fahrenheit within the required range. Cleaning supplies and other chemicals are kept under the sink locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to bedroom #5. Laundry room has a washer, dryer, detergent and is kept locked at all times. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one single latching gate. LPA observed a covered, locked, empty jacuzzi at the time of the visit. LPA observed one (1) detached, outdoor garage which contained furniture and is inaccessible to residents. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. GARAGE: The facility has two (2) garages. One (1) attached and one (1) detached. The attached garage is accessible from the home adjacent to room #5 and staff rest area. LPA observed a portion of the garage to be used as on office, and the remainder as storage of emergency food and water, personal protection equipment (PPE) , incontinent supplies, and an extra refrigerator/freezer that was checked for proper labels and expiration dates.LPA observed two (2) of two (2) garages. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Resident Records were reviewed beginning at 10:41 a.m. Four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:31 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two (2) out of five (5) staff training's were missing the specific date and time they were conducted. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 1:19 p.m. Medications are centrally stored and locked in a closet adjacent to bedroom #5. Medications for two (2) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were properly documented on the centrally stored medications and destruction record, stored, locked and inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. No errors observed during review. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator confirmed that all information is accurate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual inspection at 11:55AM. The LPA was greeted by staff and informed them of the reason for the visit. Incoming Administrator Melissa Shubin arrived at 12:34PM. Entrance interview conducted. Beginning at 11:59AM, the LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: The facility contains 5 (five) bedrooms for resident use. 4 (four) rooms are designated for private use and 1 (one) is a shared room. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with soap and paper towels. Hot water temperature was measured in both resident restrooms and was within the required range. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Hardwired combination smoke and carbon monoxide detectors were tested at 04:01PM and were operational at the time of the visit. The LPA observed required postings throughout the common space. The washer and dryer are located in a laundry room next to the medication closet. The laundry room is locked and inaccessible to residents in care. KITCHEN: Knives and cleaning supplies are stored locked and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable foods and non-perishable food. The fire extinguisher was fully charged and purchased on 11/24/2024. OUTDOOR AREA/GARAGE: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident use and is single-latched. The backyard contains a hot tub, which was observed to be covered and inaccessible to residents. There is also a bird bath in the backyard, however residents are supervised while in the backyard and no current residents have been identified to be at risk with access to the smaller water feature. The garage is attached to the property and is locked and inaccessible to residents. Cleaning supplies and disinfectants are stored locked in the garage, as well as extra food and emergency supplies. RECORDS: Records review began at 12:42PM. Residents’ records were reviewed for, but not limited to: care plans, medical records, admissions agreement, consent forms. 5 (five) of 5 (five) resident records reviewed were missing the needs and service appraisal (reassessment). Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. 5 (five) of 5 (five) staff files reviewed contained all required documents. MEDICATIONS: Medications review began at 02:52PM. Medications are centrally stored and locked in a closet next to the laundry room; medications are labeled and were checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record form. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's Emergency Disaster Plan, which was observed to be complete and updated annually as required. LPA noted the facility staff are aware of and following Infection Control policies and procedures, but did not have a written Infection Control Plan. Incoming Administrator completed the document during today's visit. Emergency disaster drills are conducted at minimum quarterly, with the last documented drill on 12/19/2024. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Liability Insurance Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency is cited (refer to LIC809-D). Exit interview conducted, appeal rights discussed, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 28, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. Facility designated staff Melissa Briones arrived shortly thereafter. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives and cleaning supplies are stored locked and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable foods, and seven-day supply of non-perishable food. The fire extinguisher was purchased on 02/21/2024. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The LPA observed required postings throughout the common space. The washer and dryer are located next to the medication closet. The laundry room is inaccessible to residents in care. OUTDOOR AREA/GARAGE: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. The garage is attached to the property and is locked and inaccessible to residents. Cleaning supplies and disinfectants are kept locked in the garage. Continues on LIC809C... RECORDS: Records review began at 1:55 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Four (4) out of six files were missing the Identification and Emergency Contact form (LIC601). Five (5) out of six files were missing the Resident Appraisal (LIC603A) form. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Six (6) out of six files were missing the Health Screening Form (LIC 503), and one(1) out of six files was missing the Personnel/Employment form (LIC 501). MEDICATIONS: Medications review began at 3:37 p.m. Medications are centrally stored and locked in a closet next to the laundry room; medications are labeled and were checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record form. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Deficiencies cited at this time. Exit interview conducted. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Feb 21, 2024